Psoriasis - more than skin deep
There are times, in my opinion, when the National Institute for Health and Care Excellence (NICE) has put cost before patient wellbeing. But on the whole, their clinical guidelines, which provide standards of care to aspire to, have made a great difference in reducing inequalities of care across the country. Their technological appraisals look at an individual drug or drugs; their clinical guidelines cover a whole medical condition. And where psoriasis is concerned, they hit the nail on the head with their reminder that psoriasis is more than skin-deep.
Psoriasis is a chronic, incurable skin condition which affects up to 1.8 million people in the UK, according to the Psoriasis Association. It's an autoimmune condition, in which your body's immune system turns on itself, as it doesin rheumatoid arthritis and coeliac disease. In normal skin, the top layer constantly sheds and is replaced from the bottom upwards. The whole process - from being made in the basement layer to being shed from the top - usually takes about four weeks. In psoriasis the whole process speeds up, leading to flaky, scaly red 'plaques' on the skin. Psoriasis can affect any part of your body, including your scalp and genital area, and can also cause painful inflammation of the joints.
But even if your joints aren't affected, psoriasis still affects much more than your skin. It can cause low self-esteem, depression and anxiety - your skin is the most visible part of you, and it's hard to ignore it when people stare at you or usher their children away from you as if you're contagious.
NICE recommends that doctors should consider the impact that psoriasis has on the psychological and social, as well as the physical wellbeing of their patients. But to do that they need to see them regularly. Yet new research shows that a third of people haven't had their psoriasis medicines reviewed by their GP for five years. About half of patients with psoriasis are on repeat prescriptions, which is fine if your symptoms are well controlled with your current treatment and you're happy with what you're using. But if you feel psoriasis (or the time-consuming, messy treatments you need to treat it with) is controlling your life, it's not fine at all. In fact, in the same survey almost 60% of people on repeat prescriptions felt at a disadvantage - perhaps feeling that if they had a repeat prescription, they had to get their medication that way rather than speaking to their GP face-to-face.
So the message is that if you're not completely happy with your psoriasis or the impact it's having on your life, it's good to talk. If you need 'ammunition' in terms of how much it's affecting your life, try looking at the dermatology life quality index before you see your doctor, or try some easy tips to make the most of the consultation. Psoriasis is so much more than just a skin condition - work with your doctor to make sure it gets the attention it deserves.